PMID: 6986855Feb 1, 1980Paper

Pathogenesis of paradoxical hypertension after coarctation repair

The Annals of Thoracic Surgery
S FoxJ A Waldhausen

Abstract

A recent review of 25 patients who had repair of coarctation of the aorta at the Milton S. Hershey Medical Center revealed a 56% incidence of paradoxical hypertension in the immediate postoperative period. Analysis of results from recent animal experiments helped us to formulate a logical explanation of the pathogenesis of this hypertension. Stimulation of sympathetic nerve fibers located between the media and adventitia of the aortic isthmus has two effects, both of which result in hypertension. The first effect is release of norepinephrine and consequential rise in systemic blood pressure. Second, this spinal reflex directly stimulates the juxtaglomerular cells to release renin and cause additional hypertension. An additional effect of this increased renin production might be the shunting of blood from mesenteric arteries, thus causing the abdominal symptoms of so-called post-coarctectomy syndrome. The inability of some patients to adapt to this spinal reflex may be related to the age of the patient when the coarctation was repaired. This probably explains the high incidence of persistent hypertension in patients who undergo coarctation repair after adolescence.

Citations

Jul 2, 2003·Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies·Kathryn Rouine-RappScott Soifer
Nov 9, 2004·Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies·Valerie A SchroederWilliam I Douglas
Sep 1, 1982·The Journal of Surgical Research·M TarkkaE Heikkinen
Sep 1, 1987·Clinical Cardiology·K MatsuyamaH Yasue
May 12, 1998·The Journal of Thoracic and Cardiovascular Surgery·D B WiestR M Sade
Jun 30, 2005·Journal of Cardiac Surgery·Mehmet OzkokeliMurat Akcar
Dec 1, 2020·Journal of Vascular Surgery Cases and Innovative Techniques·Fei JintaoMa Wei

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